Provider Demographics
NPI:1891038568
Name:ABRAHAM BALDWIN AGRICULTURAL COLLEGE
Entity Type:Organization
Organization Name:ABRAHAM BALDWIN AGRICULTURAL COLLEGE
Other - Org Name:ABAC STUDENT HEALTH SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:VP PLANNING & OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-391-4875
Mailing Address - Street 1:2802 MOORE HWY
Mailing Address - Street 2:ABAC 52
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31793-5679
Mailing Address - Country:US
Mailing Address - Phone:229-391-5030
Mailing Address - Fax:229-391-5031
Practice Address - Street 1:2802 MOORE HWY
Practice Address - Street 2:ABAC 52
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31793-5679
Practice Address - Country:US
Practice Address - Phone:229-391-5030
Practice Address - Fax:229-391-5031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-01
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health